Cardiac Catheterization and Interventions in Pediatric Patients on ECMO: Analysis of the IMPACT Registry

There are limited published studies on the performance and safety of cardiac catheterization in pediatric patients on extracorporeal membrane oxygenation (ECMO). We sought to understand the utilization and procedural safety of cardiac catheterization in pediatric patients on ECMO. We also aimed to understand differences in the types of interventions and outcomes in patients with single ventricle (SV) physiology compared to those with biventricular physiology.

Characteristics and outcomes for patients undergoing cardiac catheterization while on ECMO were collected from the American College of Cardiology National Cardiovascular Data Registry: IMPACT (Improving Pediatric and Adult Congenital Treatment) Registry from 2011-2022.

There were 3473 cardiac catheterizations performed on 2980 pediatric patients during the study period. Patients with SV comprised 31.6% of the population. Survival to hospital discharge was 53.2% overall, 45.2% in patients with SV, and 56.8% in patients with 2 ventricles. Interventional procedures occurred in 52.5% of cases. Major adverse events occurred in 11.5%, with arrhythmia, bleeding events, and unplanned cardiac/other surgeries being the commonest. Regression analysis found SV was significantly associated with major adverse events, as were interventional procedures, female sex, non-Hispanic race, diabetes mellitus, procedure status classified as salvage vs elective, and systemic heparinization.

This is the first large, multicenter review of safety and outcomes in pediatric patients undergoing cardiac catheterization while on ECMO. The study identifies common adverse events during the procedure as well as risk factors associated with the same. The presented data can serve for benchmarking, quality assessment as well as potential future research.